New Procedure Offers Relief from Chronic Back Pain

07/02/99    Portland, Ore.

OHSU's Pain Management Center is the only center in Portland to offer IDET heat therapy procedure.

Back pain is the second most common reason that patients seek medical care for chronic pain (behind headaches). While most people are familiar with the idea of a "slipped disc" causing pain by pressing on a nerve, research now indicates that the discs in between the vertebrae are a frequent cause of chronic back pain themselves. In these cases, the pain is caused by the growth of abnormal nerves and blood vessels in intervertebral discs that have been injured or worn down. Until recently, the only adequate treatment for patients who did not respond to noninterventional treatment was surgical fusion, a process that carries significant expense and risk.

Physicians at the Oregon Health Sciences University Pain Management Center are using a new procedure to treat patients with this type of pain (discogenic pain). Intradiscal Electrothermal Therapy (IDET) is a minimally invasive outpatient procedure that uses heat to treat the injured intervertebral disc.

In this treatment, a pain management specialist uses X-ray guidance to insert a needle into the injured disc. Then, a coil is placed into the disc and is heated to approximately 90 degrees centigrade (194 degrees Fahrenheit) for 15 to 20 minutes. The heat destroys the abnormal nerves and blood vessels and remodels the injured connective tissue in order to re-stabilize the disc. Most patients have at least 50 percent of their back pain relieved within a few days of the procedure and experience at least a 70 percent improvement of function. The treatment also appears to be effective in the long term.

Patients are sent home that same day, so no hospital stay is necessary. The only external evidence of the procedure is a Band-Aid over the needle site. The therapy is so effective patients often feel relief from pain immediately following the procedure. Additionally, the doctors have noted immediate changes in the discs that indicate early healing.

"This is so exciting for our patients because it offers them an opportunity to significantly reduce debilitating pain and allows them to resume their active lifestyles with a simple, noninvasive, outpatient procedure," says David M. Sibell, M.D., assistant professor of anesthesiology at OHSU.

Since IDET was approved by the Food and Drug Administration in March 1998, more than 10,000 patients nationally have had the procedure. Advantages over traditional therapies include increased effectiveness, significantly reduced cost and no need for hospitalization. There have also been no significant adverse events reported since the procedure was approved.

IDET is not promoted as an option for everyone. Older patients are less likely to benefit, as their ability to heal the disc is limited. For patients with severe spinal injuries, or severe degeneration, surgical fusion may be the better option. IDET is most appropriate for patients who have tried other conservative therapies such as physical therapy, psychological therapy and medications, but still have significant chronic pain due to injured or degenerated intervertebral discs.

Physicians at OHSU's Pain Management Center have performed IDET on several patients since they began offering the treatment in May. The center offers patients the appropriate psychological evaluation, as well as the physical therapy that is crucial to the optimization of recovery.

NOTE TO EDITORS: Dr. Sibell is available to demonstrate how the IDET equipment is used, show X-rays of patients and answer any questions about the procedure. To make arrangements to cover this story, please call Martin Munguia at 494-8231.